Introduction <p>The relationship between household air pollution from solid fuel use and hypertension remains uncertain, especially in low- and middle-income countries.</p> Aim <p>We aimed to examine the association between use of solid fuels in households and hypertension in a large, nationally representative sample from Peru.</p> Methods <p>We conducted a cross-sectional analysis of 137,012 adults using data from the 2020–2024 Demographic and Family Health Survey. Cooking fuel exposure was categorized as no exposure (clean fuels), moderate exposure (solid fuel with chimney), or high exposure (solid fuel without chimney). The primary outcome was hypertension, defined as a mean systolic/diastolic blood pressure ≥140/90 mmHg or self-reported diagnosis. The secondary outcomes were systolic and diastolic blood pressure. Modified Poisson and linear regression were used to estimate adjusted prevalence ratios (aPRs) and beta coefficients with their 95% confidence intervals (CIs), respectively.</p> Results <p>In the adjusted analysis, high exposure to solid fuel was modestly associated with a higher prevalence of hypertension (aPR 1.08, 95% CI 1.02–1.14) compared with clean fuel use. Moderate exposure showed no significant association (aPR 1.01, 95% CI 0.95–1.08). Stronger associations were observed in women (aPR 1.14, 95% CI 1.05–1.23) and urban residents (aPR 1.14, 95% CI 1.05–1.24). High exposure was also associated with small but significant increases in systolic (β = 0.65, 95% CI 0.20 to 1.1 mmHg) and diastolic (β = 0.54, 95% CI 0.26 to 0.81 mmHg) blood pressure.</p> Conclusion <p>High-intensity exposure to solid cooking fuels, particularly without adequate ventilation, was modestly associated with hypertension and small increases in systolic/diastolic blood pressure. These findings emphasize the importance of ensuring access to clean energy and enhancing kitchen ventilation, particularly among women and urban populations.</p> Graphical Abstract <p></p>